Pacific Business Review International

Volume 6, Issue 11, May 2014

A study on Service quality and customer satisfaction of selected Private

hospitals of Vadodara City

Dr. Darshana R. Dave

Abstract

Professor, G H Patel Post graduate Institute

of Business Management, Sardar Patel University,
VallabhVidyanagar.

The health care sector of any country depends on socio economic development
and the government's priority for the same. Since India has followed the mixed
economy the health care sector also has mixed participation. The house hold
spending on private healthcare is more than on public spending. Gujarat is
also growing fast in economic development. Due to increased competition,
service quality is becoming very important. The research study has been
conducted to find effect of service quality on patients' satisfaction and
customer loyalty in private hospitals of Vadodara City.

Reena Dave
Asst. Professor, SEMCOM, Sardar
Patel University, VallabhVidyanagar.

Keywords:
Service quality, patient satisfaction, hospital services.

Introduction
The provision of medical care varies across countries and the nature of such
provisioning is determined by the socio-economic and political forces in a
given society. Although there is great variety in provisioning, broadly there
are three major types. First, there are countries where the state plays a central
role in the finance, provision and administration of services but at the same
time private interests in the form of individual practice, hospitals and other
supportive services coexist. Second, there are countries where the state is the
sole provider of medical care and no private interests are allowed. Third, there
are countries which rely largely on the market for the provisioning of services.
In the aftermath of the Second World War the general consensus in Europe as
well as in the newly independent states of Africa and Asia was in favor of a
planned economic development.In developing countries on the other hand, the
degree to which the state has been involved in the provision of health services
has varied somewhat, but the support for universal coverage has been high on
the popular agenda. This is related to the fact that in some countries of south
Asia (Sri Lanka and India) the initial years of independence witnessed health
services taking a large share of planned outlays for investment in
development.
Healthcare in India
Over the last five decades several committees have been set up by the
government to review various aspects of health services development in the
country. Prominent among these were the National Planning (Sokhey) Subcommittee of the National Planning Committee (1948) and the Health Survey
and Development (Bhore) Committee (1946) which provided the blueprint for

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development of health services in independent India.

India's healthcare system rests on a primary healthcare system that
is grossly inadequate and falls woefully short of what it should be
to ensure that our people have access to at least basic healthcare.
According to the Economic Survey 2009-10, only 13 per cent of
the rural population has access to a primary healthcare center with
33 per cent having access to a sub- center, 9.6 per cent to a hospital
and 28.3 per cent to a dispensary or clinic. India has a rudimentary
network of public hospitals there was a shortage of 4,504 primary
health centers and 2,135 community health centers in 2009.
India also carries the world's largest burden of maternal, newborn
and child deaths. At the beginning of this Millennium in year 2000,
189 countries and 23 international health agencies had pledged to
reduce child under-5 mortality by two-third (Millennium
Development Goals 4) and to reduce maternity mortality by threefourths (MillenniumDevelopment Goal 5) by 2015.
Health Profile of Gujarat
Gujarat state, situated on the west coast of India, accounts for 6%
of the area of the country and 5% (51 million) of the population of
India making it rank tenth in the country Gujarat has 27 districts
subdivided into 226 blocks, 18,618 villages, and 242 towns. The
decadal population growth rate (1991-2001) of the state has been
22.6%, which is higher than that of India (21.5%). Gujarat is one of
the most urbanized states in India, with 37% urban population.
Gujarat has been ranked third in the country in terms of growth
during the 10th five year plan (2002-2007). The state has registered
an overall Gross State Domestic Product (GSDP) growth rate of
12.99 percent. Gujarat has remained among the top three of the 15
largest states in India in attracting industrial investments all
through the 90s and the early part of this decade. Based on the
wealth index, the state of Gujarat is wealthier than the nation as a
whole. Almost one-third of Gujarat's households (56% of urban
households and 15% of rural households) are in the highest wealth
quintile, compared to one-fifth of households in India. Only 7
percent of households in Gujarat (1% of urban households and
12% of rural households) are in the lowest wealth quintile.
Literature Review
The structure of the health care system in India is complex and
includes various types of providers. These providers practice
different systems of medicines and facilities. The providers and
facilities in India can be broadly classified by using three
dimensions: ownership styles (public, private not for profit,
private for-profit and private informal); systems of medicines
(allopathic, homeopathic and traditional); and types of facilities
(hospitals, dispensaries and clinics). These dimensions are
interdependent and overlapping (Bhat,1993).
This increasing importance has raised requirements for health care
marketing. According to American Marketing Association
Marketing is an organizational function and a set of processes for
creating, communicating and delivering value to customers and for
managing customer relationship in ways that benefits the
organization and its stake holders (Kotler Philip, Sholawitz Joel et
al, 2008)
Kenneth E. Covinsky, and Gary E. Rosenthal, et al.
(1999)interviewed patients at admission and discharge to obtain
two measures of health status. At discharge, they also administered

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a 5-item patient satisfaction questionnaire. They assessed the

relation between changes in health status and patient satisfaction.
In two sets of analyses, that controlled for either admission or
discharge health status. They found that Patients with similar
discharge health status had similar satisfaction regardless of
whether that discharge health status represents stable health,
improvement, or a decline in health status. The previously
described positive association between patient satisfaction and
health status more likely represents a tendency of healthier patients
to report greater satisfaction with health care .They suggested that
changes in health status and patient satisfaction were measuring
different domains of hospital outcomes and quality.
Alaloola (2008)conducted research survey to find Patient
satisfaction in a Riyadh Tertiary Care Centre. There was a
significant satisfaction with room comfort), room temperature,
room call button system, room cleanliness and respectful staff.
Patients were significantly dissatisfied with phlebotomists not
introducing themselves, not explaining procedures and physicians
not introducing themselves. SeetharamanHariharan, Prasanta
Kumar Dey (2010)introduced a quality management framework
by combining cause and effect diagram and logical framework. An
intensive care unit was identified for the study. They found that
patients improved infrastructure, state-of-the-art equipment, well
maintained facilities, IT-based communication, motivated
doctors, nurses and support staff, improved patient care and
improved drug availability were considered the main project
outputs for improving performance. The proposed framework was
used as a continuous quality improvement tool, providing a
planning, implementing, monitoring and evaluating framework
for the quality improvement measures on a sustainable basis.
RituNarang (2010)applied 20-item scale and distributed to 500
users of health care centers comprising a tertiary health center, a
state medical university and two missionary hospitals in Lucknow,
India. The scale was found to be reliable to a great extent with an
overall Cronbach alpha value of 0.74. Health personnel and
practices and health care delivery were found to be statistically
significant in impacting the perception. Respondents were
relatively less positive on items related to access to services and
adequacy of doctors for women. The tertiary health center was
rated poorer than the medical university and missionary hospitals..
Policy makers need to consider the requirements and opinions of
patients to effect substantial change and signicant improvement
in the quality of their health care services for better and increased
utilization of their services. The access to health care services
requires immediate and urgent attention from the policy makers. In
addition, they need to improve upon the number of rooms,
reception and follow-up facility along with availability of drugs
and doctors for women. This tool may be applied for qualitative
assessment of the services of health care programmes as well as
health care centres of India.
SandipAnand( 2010)carried out the follow-up survey in Tamil
Nadu, Maharashtra, Bihar and Jharkhand. Dimensions include:
service proximity, doctor availability, waiting time, medicines,
facility cleanliness, dignified treatment, privacy, service
affordability and treatment effectiveness. Findings indicated that
doctor availability, waiting time, cleanliness, privacy and
affordability at private health facilities enhance the probability that
a health facility will be used for any reproductive health purpose.

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Volume 6, Issue 11, May 2014

Their ndings indicated that doctor availability, waiting time,

cleanliness, privacy and affordability enhance private
reproductive health service use at the combined four state level. At
the combined states, medicine availability and treatment
effectiveness at public health facilities enhances use. It appeared
from their ndings that service quality norms were not properly
established in any Indian public or private systems.
Havvaaha (2010)found Patients preferred private hospitals due
to their belief that private hospitals provide qualitative health
service in Turkey. But this did not mean that they encounter
sufficient services. On the contrary, a large number of patients
complain about services given by private hospitals. The
complaints were mainly about the length of the time that they wait
for treatment and the consultation time given to them. As a result,
this study indicated that satisfaction of the patients seem to be the
most important factor for the private health care providers.
The literature review suggests that a study of perception of patients
towards service quality of hospital needs to be addressed with
specific reference to private hospitals.
Research Methodology:
The study was carried out keeping in mind following objectives:

To analyze factors affecting selection of hospitals by

consumers.

To examine impact of perceived service quality on consumer

satisfaction.

To establish relationship between satisfaction and patients

loyalty.

Hypotheses: Following hypotheses were put to empirical

testing for the given research:
(1) Service quality and consumer satisfaction positively
influence the loyalty of clients.
(2) Reputation of doctor influence significantly in selecting
hospitals.
(3) There is no difference between patients' expectation and
perceptions of hospital performance.
(4) There is no difference between the hospital performance
perception of male and female patients.
(5) There is no association between the expectation of patients
and their education.
Population of the study
The population considered for present study is all persons of
Vadodara who was admitted in the private hospitals or those who
had taken treatment from private hospitals. The sample was drawn
from Vadodara, chosen carefully for their widely accepted
characteristics.
Sample size
From the city of Vadodara one hundred (100) respondents were
selected using non probability convenience sampling and their
interviews were taken.

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Data Collection Method

In present research, personal survey method was used for data
collection.
Data Collection Instrument
The data collection instrument used in this study was structured,
closed ended questionnaire. The questionnaire also contained
questions to measure service quality in private hospitals. Minor
modifications were made to the wording of the 23 SERVQUAL
items and four items relating to access and credibility taken from
Parasuraman, Zeithmal and Berry (1985) were added. Here twenty
three (23) statements were asked to respondents, first to know their
expectation and then their perception. The statements were divided
into five dimensions of service quality which are Tangibility,
Reliability, Responsiveness, Assurance and Empathy.
Tools and Procedure for Analysis:A service quality measurement model that has been extensively
applied, is the SERVQUAL model developed by Parasuraman.
The collected data (response of the selected respondents) were
finally entered in Micro Soft Excel and data sheet (master chart)
was made in SPSS. Statistical tests / techniques applied for the
study are Uni Variate Analysisin form of frequency tables, Bi
Variate analysis using Cross tabulation with Chi-Square test,
Paired t-test, and ANOVA one way classification.
Data analysis and findings:
Consumer's perception is the main indicator of quality in health
care service. Quality of health care is the most optimal degree of
health outcomes by delivery of cost effective and efficient
professional health services to people. The basic objective of the
present study is to focus the service quality perception of
consumers from health care service provider. The primary data are
collected from selected private hospitals of Vadodara city.
As far as gender proportion is concerned, it was 71 per cent male
and 29 per cent female. From the selected respondents, 72 per cent
were married and 28 per cent were unmarried respondents. During
the data collection, the respondents were asked for their
educational qualification. In the study 59 per cent were graduates,
39 per cent were post graduates, 9 per cent were higher secondary
passed, and 1 per cent had professional degree. Out of the total
sample 20 per cent of respondentswere employees of private firm /
company, 19 per cent were farmers, 15 per cent were
businessmen,and remaining 12 per cent female respondents were
house wives.
It is important to find the decision makers for hospital services.
Respondents were asked who influences much on hospital
selection decision. It is found that 37 per cent respondents said that
family as important decision maker followed by self 33 per cent.
Whereas 22 per cent said it was their joint decision for hospital
selection.
To find major source of information for healthcare service
providers, respondents were asked on sources of information about
hospital. Family is found as major source of information (41 per
cent)followed by friends (37 per cent) and 13 per cent respondents
said that they came to know about hospital through advertisements
(Appendix table -2).

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To analyze and understand the criteria for hospital selection,

respondents of Vadodara city were asked to rate the criteria for
selection of hospitals on a five point scale from least preferred to
highly preferred. It was found that 92 per cent of respondents had
given first preference to doctors' qualification followed by
experience of doctors (91 per cent). It was also found that
reputation of hospitals was influencing factor along with extra
facilities (89 per cent) available in the hospital. Respondents
believed that hospitals should be situated in nearby area /location
(88 per cent).
Healthcare service providers are facing problem of patients'
loyalty due to increased competition, access to information
technology and many more reasons. Respondents were asked
about their future choice of private hospital. Out of total
respondents 61 per cent said they would like to come again to the
same hospital in future. Whereas 30 per cent said they would not
like to come again to the same hospital followed by 9 per cent
remaining neutral. 60 per cent of total respondents agreed that they
would never switch over to other hospitals. 31 per cent of them
remained indifferent for the same and 13 per cent remained silent.
When respondents were asked about their willingness to
recommend others, 59 per cent of total number of respondents
agreed to recommend the hospital to others, whereas 28 per cent
showed negative opinion followed by 13 per cent who did not
respond to the question. To find the most preferred serviceof
hospitals respondents were asked to give weightage to services.
Chi square test is applied to check association between need for the
best treatment and gender. The study revealed that there was no
significant difference between the male and female for the desire
of best treatment. Respondents between the age group between 31
to 40 years had given highest importance tocleanliness and
hygiene. It was found that young patients were more quality
conscious than older patients. ANOVA One waytest is applied to
check age wise gap between expectation and perception. It was
found that there was no significant difference between different
age groups and patients' expectation and perception, as p-value >
0.001 (Appendix table- 3). The researcher also tried to establish the
relationship between education and expectation and perception.As
the p-value is less than 0.001, it can be inferred that there is no
significant difference in gap between expectation and perception
of respondents with different educational qualifications (Appendix
Table-4). It was also found that 26 per cent of total respondents
were satisfied with hospitals services and remaining 76 per cent
were dissatisfied with hospitals services (Appendix Table-5).
To establish relationship between patients'satisfaction and
loyalty,chi square test was applied, it was found that there is
significant association between the feelings of satisfaction /
dissatisfaction and willingness to come again to the hospital(pvalue <0.05). It was also found that there is significant association
between the satisfaction/dissatisfaction levels and their
willingness to never switch over to other hospital (p-value < 0.05).
The study also revealed that there is significant association
between the satisfaction/dissatisfaction levels and their tendency
to recommend the hospital to others (p-value < 0.05).

is based on primary data which are collected from indoor and

outdoor patients of private hospitals of Vadodara city of Gujarat.
Various patients from various disciplines i.e. general medicine,
pediatrics, general surgery, gynecology and orthopedics etc. were
surveyed with the help of a structured questionnaire.
In case of health care services still word of mouth i.e. information
regarding hospitals and services from family play an important
role. It was found that respondents had given more preference to
doctors' qualification and experience of doctors. It was also found
that reputation of hospitals is influencing factor along with extra
facilities, available in the hospital. Respondents believed that
hospitals should be situated in nearby area /location.There was
significant influence of education and income of the respondents
on patients' loyalty.
Health care service providers should disseminate correct
information from time to time as more quality information leads to
patient awareness and satisfaction. The hospitals should have
convenient operating hours and nurses should give individual
attention to patients. Especially this problem is found in private
and trust run hospitals. The study revealed that to improve patient
satisfaction, healthcare service providers must focus on quality
improvement strategies.
References
Bhat , R.(1993). The private/public mix in health care in India.
Health Policy and planning,8(1),43-56.
Havvaaha (2010), 'Service Quality in Private Hospitals in
Turkey'; Journal of Economic and Social Research 9(1),
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International Institute of for Population sciences (IIPS) and Macro
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Kapil Dave, Gujarat economy grows twice as fast as India's. DNA,
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Kenneth E. Covinsky, and Gary E. Rosenthal, et al. (1999), The
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Philip,Sholawitz Joel and Steven J.Robort,2008 titled

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Tertiary Care Centre'; International Journal of Health
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Conclusions and Recommendations

PadiaDarshana, District Human Development Reports in Gujarat:

Tool for Mainstreaming Human Development in
Planning, Government of Gujarat.

In order to understand the needs and satisfaction of consumers of

healthcare services an empirical study was undertaken by the
researcher. The study on service quality and customer satisfaction

Parasuraman, A., Leonard A. Berry and Valerie A. Zeithaml

(1985).A Conceptual Model of Service Quality and its
Implications for Future Research.Journal of Marketing,

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49 (Fall), 41-50.
Paul Vinod Kumar et al, Reproductive health and child health and
nutrition in India: meeting the challenge, The Lancet,
2011; 377 (9762): 332 -349.
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Rural Health Statistics Bulletin 2010, Office of Registrar General

of India, India, March 2010.
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Appendix

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